Bilateral adrenalectomy as a day case?

Karim Meeran, Vas Constantinides and Fausto Palazzo

A 34 year old patient was referred with recurrent Cushing’s disease. She had three transphenoidal hypophysectomies  in Scotland, and was initially in remission. She had now  moved to London.

On referral she was obviously Cushingoid and failed a LDDST.

Pituitary imaging revealed an empty sella.

Options presented to the patient included repeat transphenoidal surgery, with a risk of further recurrence, or bilateral adrenalectomy. The patient had already experienced pituitary surgery, but not abdominal surgery.

In order to make an informed decision she wished to know the details on all the current options for adrenal  surgery, including the results of each.  

Traditional open transperitoneal  bilateral adrenalectomy  was major abdominal surgery, or alternatively  required removal of both 12th and sometimes 11th ribs. Both operations were associated with considerable pain,  post operative   intensive care and a prolonged hospital stay.

Minimally invasive / “traditional keyhole” approach  is clearly superior to open surgery and is currently used in most centres.  However an alternative minimally invasive approach - retroperitoneoscopic adrenalectomy  - is now available in 2 UK centres including Hammersmith Hospital. This newer technique  presented at this meeting by Professor Walz two years ago will be discussed along with a comparative study of the Hammersmith experience of minimally invasive (laparoscopic v retroperitoneoscopic) adrenalectomy .